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Few units in the British army can have fared worse on 1 July 1916 than the Lonsdales. Formed of volunteers from north-west England swept up in the outpouring of patriotic fervour at the start of the First World War, the 850-strong battalion joined the walking-pace advance on the first day of the Battle of the Somme. Within hours, they had lost more than 500 men. Not only the commanding officer – shot in the head as he leapt from a trench – but the second-in-command, the adjutant and every one of the company commanders had been either wounded or killed.

The survivors, next put to work digging up the remains of their friends, lived in a miasma of decomposing bodies and faced continuous shelling without sleep. A week after the massacre, they were ordered to go over the top again. This time they refused. Command was apoplectic. At the troops’ request, Lieutenant George Kirkwood, the battalion’s medical officer, was despatched to see them. He saw at once that the men were at their nerves’ end, and testified in a written report that most of them were suffering from the mysterious new ailment known as “shell shock”.

The tragic fate of the Lonsdales forms one of the most telling subplots in Breakdown, the historian Taylor Downing’s superb account of the military’s response to the epidemic of shell shock that broke out during Britain’s “Big Push” on the Somme. Even before the deluge of books published to coincide with the centenary of the First World War, historians had spent a great deal of time debating the impact of trench warfare on men’s minds. Nevertheless, Downing manages to offer a useful perspective by
unpacking the pivotal role that the cataclysm in the Somme played in the birth not just of military psychiatry, but a new era in our understanding of mental health. Although clinical psychology was then in its infancy, he shows how the influx of shell-shock cases put the study of the human mind on “a large-scale and very public map”. Vivid first-person accounts leave no doubt about the price a generation of citizen-soldiers paid.

Downing sets the scene by chronicling the scramble to muster a force capable of confronting the German army, 25 times the size of the regular British army at the outbreak of war. It was the clerks, miners, dockers, farm labourers, tradesmen, students and factory ­workers who flocked to join “Pals Battalions” such as the Lonsdales who formed the backbone of the British force at the Somme. Many were annihilated on the first day of battle: there were 57,470 casualties, of whom 19,240 were killed or died later of their wounds. It was the worst single-day loss the British army had suffered.

Until then, the top ranks had viewed shell shock largely as an irritant. The carnage at the Somme produced a surge in psychiatric cases – an estimated 53,000 to 63,000, or 20 per cent of casualties. “The eyes pop out of their sockets, the expression becomes fixed and glassy . . . the skin becomes yellow, the cheekbones protrude,” one medical officer wrote. “From time to time a cold shudder runs through the body and the teeth chatter.” For the public, such lurid descriptions of Gothic-horror-style symptoms elicited a mixture of morbid fascination and pity for the victims of a syndrome that seemed emblematic of the new heights of cruelty unleashed by the age of industrial war.

Before the Somme, the army had shipped most men who broke down back to Britain, anxious to avoid clogging the trenches with “lunatics” or “malingerers”. The battle forced the generals to reconsider. Charles Samuel Myers, a compassionate Cambridge don seconded to the Royal Army Medical Corps, had long argued that men might be spared irreversible psychological collapse if treated quickly near the front with a few days of good food and rest. Despite the army’s misgivings, he was allowed to set up four tented treatment centres and returned many men to the line – establishing the principles of “forward psychiatry” still used by the British military today.

Nonetheless, command remained deeply reluctant to acknowledge the legitimacy of psychiatric injury and continued to view breakdown as a disciplinary offence, punishable if need be by firing squad. “Senior figures in the army regarded shell shock not so much as an individual trauma that needed to be understood, requiring sympathy and treatment, but as a collective threat to the army as a whole,” Downing writes.

Clearly this thinking informed the res­ponse to the Lonsdales’ reluctance to advance once more to their deaths. General Hubert Gough, commander of the Reserve Army, to which the battalion belonged, wrote it was “inconceivable” that soldiers could “degrade themselves in such a manner” and “show an utter want of manly spirit”. Four sergeants were arrested and charged with “cowardice”; an inquiry was launched. Kirkwood was demoted to serve as an orderly and the surviving Lonsdales were disarmed and publicly reprimanded – a terrible humiliation for enthusiastic volunteers who had been much praised.

Though attitudes in the army have come a long way, Gough’s bulldog response lingers today in the stigma that prevents many soldiers from seeking help for post-traumatic stress disorder, our modern conceptualisation of the psychic cost of war. A century after the slaughter of the trenches, Downing’s book is a necessary reminder that trauma is an injury, and not a sign of weakness.